Fran Lowry

June 30, 2011

June 30, 2011 (Brighton, United Kingdom) — Adding an anti-inflammatory medication to an antidepressant may augment efficacy and enhance depression treatment, researchers said here at the International Congress of the Royal College of Psychiatrists 2011.

Carmine Pariante, MD, PhD, from the Institute of Psychiatry, Kings College, London, United Kingdom, told delegates attending the International Congress of the Royal College of Psychiatrists 2011 that a series of studies published during the last 5 years offers clear evidence to support the combination therapy with anti-inflammatory drugs and antidepressant medication.

Dr. Carmine Pariante

"Inflammation is a key element in the pathogenesis of depression, and using anti-inflammatory drugs is a novel strategy that uses a completely new antidepressant approach, finally, after 20 years of me-too drugs," Dr. Pariante told Medscape Medical News.

Speaking on behalf of the Psychiatric Research into Inflammation, Immunity and Mood Effects (PRIME), a consortium of UK researchers in biological psychiatry, Dr. Pariante said that it is well known that long-term illness is a trigger for depression and that people with chronic disorders also have high levels of inflammatory markers or cytokines.

"These links have now been shown by clinical trials carried out by PRIME researchers from Brighton, Glasgow, and Bristol, as well as King's College. Recently, 2 studies by UK scientists have shown that levels of clinical depression increased significantly when people were given medication for hepatitis C and vaccinations against typhoid, both of which are known to raise levels of inflammation.

Promising Approach for Other Conditions

As reported by Medscape Medical News, combination therapy with antibiotics has also shown promise in severe multiple sclerosis, fragile X syndrome, stroke, and Parkinson's disease.

During his presentation, Dr. Pariante discussed an article by Julien Mendlewicz, MD, from the Department of Psychiatry at Erasme Hospital in Belgium, and colleagues, which showed that acetylsalicylic acid (ASA) added to a selective serotonin reuptake inhibitor (SSRI) improved the response rate and extended time to remission in depressed patients who had failed to respond to 4 weeks of SSRI treatment alone.

"This study was chosen for discussion because it is the most classical of the anti-inflammatory drug studies, and the ASA has a good side effect profile, at least at the dose used. There were also some animal data from the same authors that suggested antidepressant efficacy, as discussed in their paper," Dr. Pariante said.

"My own research has demonstrated high levels of inflammation in a variety of depression models," he added.

High levels of inflammation induce depressive symptoms, especially those that are more somatic, such as tiredness, loss of appetite, and disturbed sleep.

"Hence, because the high levels of inflammation are participating in the pathogenesis of depressive symptoms, decreasing inflammation has a therapeutic antidepressant effect," he said.

Minocycline One of Many Potential Options

John Potokar, MD, of the Academic Unit of Psychiatry, Bristol University, United Kingdom, noted that 1 theory of how drugs that reduce inflammation work in depression holds that evolutionary biology is responsible for both depressive traits and inflammation.

"All the behavior that we call depression can also be seen in sickness behavior...the behavioral changes that occur during inflammation. It may be that humans evolved these behaviors as a protective mechanism," Dr. Potokar said in a statement released at the Congress.

Dr. Pariante said he is also considering the antibiotic minocycline, which dampens inflammation, as a possible adjunct to antidepressant medication.

"We are interested in minocycline because it is cheap, well tolerated, and has already been used in other samples of patients with mental health problems in the context of inflammation, but never, surprisingly, in depression. It is also important to stress that minocycline is used as an antibiotic, but the anti-inflammatory effects, which we hope to use to help depression, are through a direct anti-inflammatory action that is independent from the antibiotic action."

The ultimate aim, he said, is to "bring forward a program of research using anti-inflammatory action in depression. Minocycline is only one of the options that we are considering."

International Congress of the Royal College of Psychiatrists (RCP) 2011. Presented June 29, 2011.

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